<p>State of Kansas PPS 5325 Department for Children and Families REV 10/12 Prevention and Protection Services Page 1 of 1 Adoption Exchange Family Status Update Form</p><p>Date: Name of person completing this form: Agency info: Phone number: E-mail address: </p><p>Family info: Parent #1: </p><p>Parent #2: </p><p>Address: </p><p>Phone Number: </p><p>Please mark the box for the action to be taken on the family Inactive Date: Reason Family identified for a child Adopted Guardianship/Custodianship Personal Reason No longer interested in adoption Other (please specify): </p><p>Re-Active Date: (If changes to composition (i.e. marriage, divorce, birth of a child, ect.) please submit an updated 3026 form instead) Reason Family no longer an identified resource Wishes to pursue adoption again Other (please specify): </p><p>Comments:</p><p>(This form supersedes CFS 3028 REV 1/10) State of Kansas PPS 5325 Department for Children and Families REV 10/12 Prevention and Protection Services Page 1 of 1</p><p>(This form supersedes CFS 3028 REV 1/10)</p>